Leadership Venango Application

Applications are due by August 6, 2027.

Acceptance notification will occur on or before September 1, 2027.

The tuition fee is $950. Scholarships are available, visit leadershipvenango.org for more information.

Please call the Venango Chamber with any questions regarding your application at (814) 676-8521. Scholarships may be available, reach out to the Chamber for details.

Participant Contact Information

Name *

Name Preferred for Name Tag *

Employer/Organization *

Business Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Work Phone

Cell Phone

Email Address *

Home Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Years Living or Working in Venango County *

0 - 11 mo. 1 - 4 yr. 5 - 9 yr. 10+ yr.

Education Background

School Name

City, State

Major

Degree

List any additional college(s), business, trade schools, or other specialized training

Employment

Account for all periods, including military duty.

Present Employer *

Current Title/Responsibility *

Date Began

Time in Position *

List previous employers, including title/responsibility, and time in position.

Professional and/or Personal Achievements *

Your highest achievements, responsibilities, or skills to date

Community Involvement *

Please list, in order of importance, up to four community, civic, professional, business, religious, social, athletic, and other organizations of which you are or have been a member. Please include: Organization Name • Position Held • Dates

Briefly explain your interest in Leadership Venango and what you hope to gain from your participation. *

References

Name - Reference 1 *

Phone - Reference 1

Relationship - Reference 1 *

Name - Reference 2 *

Phone - Reference 2

Relationship - Reference 2 *

Candidate and Sponsor/Employer Agreement

I agree to the participant requirements of Leadership Venango, including attendance at all sessions and participation.

Please type your name here to indicate your agreement to these terms *

We will contact your employer to confirm approval for your participation in the class and the financial commitment.

Employer Name *

Employer Title *

Employer Phone

Employer Email *

Leadership Venango Application - Class of 2028